Denials Specialist

A company is looking for a Denials Specialist - REMOTE.

Key Responsibilities

Validate denial reasons and ensure accurate coding in DCM, coordinating with the Clinical Resource Center as needed

Generate appeals based on dispute reasons and contract terms, following payer guidelines for submission

Research contract terms and compile documentation for appeals, escalating denial trends to management

Required Qualifications

High School Diploma or equivalent; some college coursework preferred

3 - 5 years of experience in a hospital business environment performing billing and / or collections

Intermediate understanding of Explanation of Benefits (EOB), Managed Care Contracts, and hospital billing form requirements (UB-04)

Intermediate knowledge of ICD-9, HCPCS / CPT coding, and medical terminology

Intermediate skills in Microsoft Office (Word, Excel)